Healthcare Provider Details

I. General information

NPI: 1477540417
Provider Name (Legal Business Name): NORWOOD CROSSING ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 05/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6016 N NINA AVE
CHICAGO IL
60631-2439
US

IV. Provider business mailing address

6016 N NINA AVE
CHICAGO IL
60631-2439
US

V. Phone/Fax

Practice location:
  • Phone: 773-631-4856
  • Fax: 773-631-4850
Mailing address:
  • Phone: 773-631-4856
  • Fax: 773-631-4850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1761603
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number0012237
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0012237
License Number StateIL

VIII. Authorized Official

Name: MRS. GAIL ANN PRETE
Title or Position: CFO
Credential:
Phone: 773-577-5325